Work addiction as a behavioural addiction: Towards a valid identification of problematic behaviour

The recent debate paper by Starcevic et al. (2018) in Australian and New Zealand Journal of Psychiatry constitutes a plea for terminological and conceptual rigour in behavioural addictions research. As such, it is a noteworthy effort to stimulate a ‘collaborative work-in-progress’ regarding the conceptualization of behavioural addiction. However, the statements presented by the authors, concerning the status of work addiction research and the newly suggested improvements to the argument for the exclusion criteria of behavioural addictions, need to be addressed.

The paper by Starcevic et al. (2018) suggests that work addiction is, among other newly proposed behavioural addictions, that ‘have a very limited clinical relevance and none are recognized as disorders […], outside the circle of supporters of the components model’ (p. 2). However, this is not the case in relation to work addiction, which has a relatively long-standing history of research (in comparison with many other behavioural addictions), preceding by more than two decades the component model suggested by R.I.F. Brown in 1993 and later adopted by M.D. Griffiths to behavioural addictions. As it was already reviewed in detail elsewhere (Atroszko and Griffiths, 2017; Griffiths et al., 2018), there has been a comparatively long period of conceptual clarification of the concept of work addiction. In practice, the component model has been applied to work addiction, specifically within the psychometric measurement context, only a few years ago. Partially, it was as an attempt to provide a short screening instrument, which could further advance the empirical research within the addiction framework, and it proved to be useful (see Atroszko and Griffiths, 2017; Griffiths et al., 2018). Furthermore, work addiction has substantial clinical relevance as supported by more than 50 years of research including anecdotal data, case studies, cross-sectional and longitudinal studies, as well as several decades of Workaholics Anonymous operating in many countries around the world (Atroszko and Griffiths, 2017; Griffiths et al., 2018; Robinson, 2014). Here, it should be noted that such seminal authors as Wayne Oates or Bryan E. Robinson have studied work addiction in their clinical practice for several decades, providing comprehensive in-depth analyses of cases of work addicts. Wayne Oates has been recognized by the American Psychiatric Association with Oskar Pfister Award in 1984 for his contributions to psychiatry. These contributions to a significant extent include the problem of compulsive overworking, approached in many among over 50 of his books and hundreds of articles. In turn, since late 1980s, Robinson (2014) systematically studied work addiction and its consequences, especially for the family of the addict. Apart from quantitative research, he documented dozens of case studies from his own clinical practice and provided information based on hundreds of case reports (Robinson, 2014). Nowadays, within the fields of organizational and work psychology, there is a considerable body of empirical research into work addiction inspired by Robinson’s as well as J. Spence and A. Robins’ conceptualizations and measurement tools which recognize it as an addictive behavioural pattern leading to negative consequences. It is a rapidly expanding area of research that awaits integration with the component model in order to reach a wider consensus regarding exact diagnostic criteria (Griffiths et al., 2018). What is more, work addiction has been associated with cardiovascular disease (CVD) since the 1970s in the high-profile medical literature (Griffiths et al., 2018). In summary, work addiction is not a newly invented nor unrecognized problem; though, researchers from outside of the work addiction field and the general public are often unaware of the legacy of the accumulated clinical insights and long-standing research. Consequently, work addiction fits very well into the criteria for behavioural addiction suggested within this ongoing debate, as it was substantiated in detail in Atroszko and Griffiths (2017) and Griffiths et al. (2018).

We should focus on a valid identification of problematic behaviour rather than the exclusion of diagnosis through recognition of underlying problems

The issue of comorbidity of behavioural addictions with other disorders has been addressed before (Griffiths, 2017), and this time, Starcevic et al. (2018) improved the argument to suggest that ‘the circumstances under which an underlying or co-occurring disorder obviates the diagnosis of behavioural addiction might include: […] the current severity of the disorder is comparable to the severity of problematic behaviour or exceeds it’ (p. 2). However, the progressive nature of addiction needs to be taken into account. The behaviour may still be problematic and may lead to severe deterioration in functioning beyond the previously present disorder; however, it may require time to observe substantial and unequivocal harm attributed to it. This is the case with all addictions, but work seems to be sensitive to this problem specifically. Some of its potential consequences such as a full burnout or physical health problems (including CVDs, death from overwork known as karoshi or suicide from overwork known as karojisatsu) or harm to the family of work addict (such as anxiety and depression among children) take time to become evident (Griffiths et al., 2018).

Using work to regulate mood may lead to prolonged and progressive loss of control over the behaviour, especially when it is a means to cope with another underlying disorder. This increasing difficulty to reduce the behaviour despite repeated attempts is well-documented in the cases of excessive working and strongly suggests that for some individuals, it is not merely a transient behaviour but an addiction with its own aetiology and symptomatology. Therefore, its recognition as an addictive pattern related to ineffective coping (congruent with the way substance addictions are currently conceptualized and diagnosed; Griffiths, 2017) would allow for the best-suited prevention and intervention programmes. If we exclude work addiction as a diagnosis in such cases, then ipso facto we do not address the problem which will affect the person harmfully and will lead to worse outcomes and prognosis than could be expected if only the underlying disorder was present. Therefore, it seems to indicate that the main focus should be placed on the valid identification of the addiction with proper criteria for its diagnosis.

Work addiction has been consistently linked to higher levels of stress in and outside work (Griffiths et al., 2018), and chronic stress is a well-recognized risk factor for major depression as well as a host of other disorders and noncommunicable diseases. The significance of the link between work addiction, depression and burnout (Griffiths et al., 2018) gains a new perspective once the socioeconomic costs of chronic stress are taken into account. The European Agency for Safety and Health at Work report published in 2014 has showed that the recently evaluated cost to Europe of depression related to stress in work was estimated to be €617 billion annually.

In conclusion, work addiction has fairly well-established clinical relevance and has been recognized as a disorder by many clinicians and researchers outside the circle of supporters of the components model. Furthermore, discounting the problematic behaviour’s potential for harm when other co-occurring or underlying disorders are present may have severe negative consequences for the prognosis concerning that individual. Finally, regarding work addiction, Starcevic et al. (2018) point out that it is not recognized as a disorder by the official diagnostic and classification systems. It will never be recognized, despite enormous suffering and costs it may bring, without wider recognition from the professionals in psychiatry and clinical psychology, concerning the advancements in its conceptualization and research.